Listen Up

Thursday, April 9, 2015

The Quantified Self and Patient- Centered Medicine

Ali Khan, MD, MPP is a clinician-innovator at Iora Health and a clinical instructor of medicine at Yale. He currently serves as the chair of the American College of Physicians’ National Council of Resident/Fellow Members. Leah Marcotte, MD is a senior medicine resident at the University of Washington. As a medical student at Penn, she served as a fellow at the Office of the National Coordinator for Health Information Technology. Among her varied policy pursuits, she serves as an associate editor for the journal Health Care. In a recent article ALI KHAN, MD and LEAH MARCOTTE, MD discuss Ezekial Emanuel' pronouncement that the annual physical examination is worthless. (worthless for what and to whom ?) The Wellness Revolt What Zeke Missed on the Annual Physical Are we being reduced to a series bits and bytes ? Can patients be distilled into a series of numbers, or symbols wnich requires a huge overlay of technology? Can human beings be defined and judged by electronic devices, computers and sensors ? The wave of HIT, mobile health,and health data exchanges bring this question to the forefront. It's not a new question, however one that is bold-faced by current events, cost, and still questionable value. We have been using bits/bytes for several decades with MRI, Ultrasound,ekg,pacemakers, implantable devices and sensors. Without these things we could not be delivering high quality care as we do now. Note that physicians definition of quality has nothing to do with length of stay, nor readmission to hospitals. Zeke,(Ezekial EmanuelM.D.) as he is called, one of the country’s foremost health experts threw a presumptive grenade into the national discourse: "the annual physical is worthless". As we watched the initial burst of reactionary fervor following his New York Times opinion piece, we weren’t quite sure what to think. Dr. Emanuel who is respected speaks from a far away place, somewhere between the NIH (National Institutes of Health and other well known Institutions. My comments are not related to the high) esteem in which I hold "Zeke" He is a welcome additon and possible heir to the ideas of another bio-ethicist, Dr Arthur Kaplan N.D. Then we realized why: in our training and burgeoning careers in primary care, neither of us has ever scheduled an “annual physical” for a patient. To us, the notion of such a visit – for scheduled, non-urgent care, and one not specifically for chronic disease management – is already dated. Given current trends in American health care delivery and professional training, we argue it is one that may well soon be obsolete. Many physicians would argue that opinion. But does that obsolescence change the value of that time – whether 15 minutes or 60 – with a patient, on a regular interval? Our perspective from medicine’s emerging front line offers a resounding no. Furthermore the indications for annual exams should be based upon diagnoses of the individual patient. One cannot extrapolate the necessity for annual physical examinations without a frame of reference. The most obvious argument for regular primary care visits is preventive care. Dr. Emanuel bases much of his argument on the validity (or lack thereof) of annual physicals. Drawing off that same evidence base, the U.S. Preventive Services Task Force sets recommendations for evidence-based screening in various populations. Even the young and healthy benefit from cervical cancer screening, initiated at 21 years of age and continued every three years provided negative results until the age of 30 (when the recommendations change slightly). Patients with higher risk earn further screenings, based on whether they smoke, their weight, their age and their family history.

Wednesday, April 8, 2015

Healthcare by Schmucks

There must be some intelligent people in government. They are hard to find,and if they rise to the top it is not infrequent they will last perhaps one term or even one year. When one is promoted to a position above the glass ceiling it is at first a rush to have been elevated to a place where you are seen,sometimes listened to maybe respected, and an easy target for those who think they know better about leading. It is not unique to healthcare. Only 17% of physicians are in solo private practice. What this means is a loss of economic freedom, the loss of integrity and honesty as an individual. Perhaps physicians are really not so unique as I once thought. Admittedly this was a primary reason for my entering the field of medicine. My other reasons are buried somewhere in a space where my MRI shows that my brain has shrunk. My physician (neurologist) showed me the MRI The ventricles were slightly enlarged, but the condition is 'stable' (what condition ?) Imagine that ! A former ophthalmologist with a shrunken brain). Perhaps I can use that as a marketing tool. "Lasik Surgery by a former pioneer and early user of Lasik" A one year special for $--.00/ Prices subject to change and we don't guarrantee results. 50,000 cases. All proceeds to go to the Alzheimer Foundation. My former patients took some solace in having a surgery by laser. It must be better...it's not surgery. It does not take much physical skill to perform lasik other than to affix several robotic tools which make the laser cuts according to a pre-determined algorithm. The skill and over-riding is judgment honed, and carved out from years of experience, a qualitative measure almost impossible to measure metric other than the length of a career. Perhaps it can be measured by the amount of brain shrinkage as indicated by an MRI. I digress, which is often the case discussing things not relevant to the theme of my paper. Back to health care by schmucks ( I love that word. I don't think it can truly be translated, summing up many people who are highly educated, trained and just don't quite get it.) They often are elected to positions of high esteem and leadership. Personally I have found in my career a certain resistance to following many of them. Perhaps it is my lack of respect for authority, a bit like my feelings for the IRS. They just don't get it, and they are led by Congress, and whoever is sleeping in the Lincoln bedroom, or in the bathroom of the oval office. No matter, usually they move on to a 'highly respected group of foundations (all non-profit, of course), such as the IOM, AHRQ, the Institute for Quality Improvement, and others. All of this brings me to the topic of today's article by Richard Amerling M.D. He is the current leader of the AMA. This position supposedly represents most or all of physicians. I don't know him personally, but he is trying to do a good job. Unfortunately Dr. Amerling does not represent any majority of U.S. physicians. I am sure he goes to sleep every nite tossing and turning thinking how truly powerless he is against HHS, CMS, the SGR and an alphabet soup of 'authorities'. Poor Richard (sorry,Dr. Amerland no disrespect intended) There seems to be no other way, so we live with compromise, the story of life, except perhaps for the Ayotollahs and those who cannot think for themselves a skill rarely taught in school these days. The article in the AMA has caused my brain to shrink even more. It is time to have a followup MRI for which I will wait two weeks to do, and then another two weeks to have a result, all while knowing that my brain is either shrinking or over-inflating with fluids. (does anyone need a spinal fluid infusion or replacement) I am willing to donate my spinal fluid for free, tested for STDs, Prions, and other infectious diseases. I cannot promise that you wont get Alheimer's or suffer the same process I seem to be going through now. I have had an epiphany about aging. I am surprised it took me this long. I have treated thousand of people over the age of 65 and I had no idea of what they were experiencing. After all they and I use denial to survive. It has taken me ten years to realize what I am experiencing. My spouse, who was an R.N. and 7 years younger than I am seems to know the story of aging. In my next article I will venture into what my cognitive powers have rendered. Scientific description with vocabulary that most people do not understand whether young, educated or not is not adequate to the task. It is a bit like watching black and white TV, never having seen color TV (that should summarize how old I am. My earliest recollection of TV is Howdy Doody and Dave Garroway. No one was capable of taking over NBC and they are still at the helm or Dave is directing NBC from wherever he may be. I would look at my elderly patients and observe forgetfulness in some, missing appointments, not complying with medication instructions and being unable to remember what they had for breakfast. My neurologist gave me a short mental status examination. ie, count backwards by 7s from one hundred while standing on one foot, or on my head. Who is the President of the U.S now. My answer was 'No one' My answer resulted in his retiring the next week,and he is ten years younger than I am. Sorry Dr. F, I meant no disrespect. i have known Dr. F all my career, and he has an excellent reputation, even if he works for a competing multi-specialty group. Damn I wish I had gone into that group when I came to town. But no I wanted to own my own practice and prove that I was 'better'. . I guess that makes me the 'ultimate schmuck' I did not mean it as a joke, however I will contribute that to the new man at the helm for Jim Colbert. However after blurting out what I thought was an original thought and now I realie just how funny it was. They say that great comedians are fast on their feet, a bit like Robin Williams R.I.P., Steve Martin, Jackie Gleason and Bob Hope R.I.P. If you are still with me and have not sucumbed to internet inattention by jumping to another site I will reward you with fact from those who I think may be schmucks but know their 'stuff' (no disrespect to my esteemed colleague Dr. Amerling, who I know would think the same things. That is what is so good about physicians, it' the 'elevator or doctor's lounge talk. That is, if it has not been turned into an administrator's office to crunch numbers to save money. I do miss those hospital sponsored lunches with filet mignon, lobster, fine wine, ice creams with fudge before going back to my office in a state of euphoria, refreshed, somewhat somonolent and content with my plight. Missing From the Debate Over The Medicare Sustainable Growth Rate: Sanity Click here to read online and comment. A popular definition of insanity---doing the same thing over and over and expecting a different result---could well be applied to the Sustainable Growth Rate. Understanding the origins of this failed policy is highly instructive as to the effects of government price controls in the Medicare system. Costs within the Medicare system started to rise faster than predicted as soon as the program was instituted. This should have come as no surprise. Millions of seniors were handed an entitlement to medical services, which of course increased the demand for these services. Physicians were allowed to charge their “usual, customary, and reasonable” rates and did so. Concern over rising costs led to various responses from the Health Care Financing Administration (HCFA, the bureaucratic precursor of the Center for Medicare and Medicaid Services), to rein in spending. These mostly took the form of price controls on physicians’ services. On its face, this is stupid policy, as payments to doctors were between 10 and 15% of total program spending. Cuts in this sector couldn’t reasonably be expected to produce much in the way of savings. And of course, going back to the dawn of civilization, price controls have never worked and have more often than not been disastrous. In 1983, HCFA began a fee freeze on Medicare payments to doctors. This was extended through 1986. Total Medicare spending increased dramatically during this period. Why? Doctors, to maintain income, increased the volume of services provided. The more patients seen, the more tests, prescriptions, consultations, and hospitalizations occur. Limiting the payment for an office visit invariably leads to less time per patient encounter. This must result in loss of quality. In 1989, HCFA moved away from paying doctors based on their UCR charges to the Resource Based Relative Value System, a socialistic construct that assigned dollar amounts to the myriad services provided by doctors. Balance billing of wealthier patients (not all seniors are poor) was severely restricted. Non-participating physicians could only charge a bit over the Medicare “maximum allowable charge.” Since they were also penalized with a lower payment rate, this increased the physician Medicare participation rate. The net result was another big pay cut to physicians, which was again followed by a major increase in total Medicare spending. It also brought larger numbers of doctors into the Medicare system, where they became highly sensitized to the dictated pricing. In 1997, the Medicare Modernization Act introduced the SGR. The idea was to base Medicare physician fees on total program performance the prior year. If total Medicare spending were above a certain target, payments to physicians would be frozen or cut in the current year. But pay cuts to doctors predictably cause total spending to increase. The Medicare Payment Advisory Commission (MedPac) recently reported that from 2002-2012 Medicare spending on physician services per beneficiary increased by 72%. A 9% increase in rates during this period was dwarfed by the growth in volume of physician services, including lab tests (91% increase), imaging (79% increase), and other procedures (up 68%). If SGR doctor pay cuts had been allowed to take place, doctors would now be getting paid pennies to see Medicare patients! This would have forced many doctors out of Medicare completely, creating a shortage (the legacy of most price controls). The SGR meets the definition of insanity. As it is, the net effect of pay cuts and freezes has been to force many physicians out of private practice, and into hospital systems, where costs are much greater. From 2002-2012, Medicare fee-for-service rates increased 9%, while the cost of operating a practice increased 27%. What’s the solution? The bill just passed by the House of Representatives and awaiting Senate action does away with the SGR, but enshrines Medicare price controls and an arbitrary update formula guaranteed to be substandard. It also furthers the push away from fee-for-service payment in favor of newer forms of managed care, such as the Accountable Care Organization. These, despite the bells and whistles, are doomed to fail. Since much of the current Medicare disaster can be traced directly to the effect of price controls, and direct payment of doctors through mandatory assignment, we should do away with these. Congress should insist that Medicare physician payments go through patients, and restore to physicians the right to balance bill. This would include being able to provide care for free to a truly indigent beneficiary (a practice that is now illegal). This would stem the flow of doctors exiting Medicare, and private practice, improve quality of care, and empower patients. Payments to physicians would likely remain flat, as volume of services would immediately decline. And this would moderate total program spending. Richard Amerling, MD (New York City) is an Associate Professor of Clinical Medicine and an academic nephrologist at Mount Sinai Beth Israel in New York. Dr. Amerling received an MD from the Catholic University of Louvain in 1981. He completed a medical residency at the New York Hospital Queens and a nephrology fellowship at the Hospital of the University of Pennsylvania. He has written and lectured extensively on health care issues and is President of the Association of American Physicians and Surgeons. Dr. Amerling is the author of the Physicians' Declaration of Independence and is a seasoned speaker and on-air contributor.

Saturday, April 4, 2015

Pain Managment ? The Role of Nutrition

Hoping to avoid medications? Try these natural options.
The answer may be in your kitchen pantry, and not in your medicine cabinet
Attributed to : Healthline

Turn to Nature

If you’re suffering from a toothache, backache, or any other type of pain, your first impulse might be to reach for a pill. Many people rely on medications, but they come with the risk of side effects, drug interactions, and the possibility of becoming habit forming. 
You may find the relief you need from a variety of natural painkillers instead.
Many herbs and spices can treat inflammation and other related conditions. These plant-based options fall under a category of medical treatment known as complementary and alternative medicine, which also includes acupuncture, yoga, reiki and other practices. When it comes to pain relief, you may be surprised at what might help you feel better.
Part 2 of 7: Willow Bark

Willow Bark

willow bark
People have been using willow bark to ease inflammation (the cause of most aches and pains) for centuries. The chemical salicin, which is similar to the main ingredient in aspirin, is found in the bark of the white willow.
Originally, people chewed the bark itself to relieve pain and fevers. Now willow bark is sold as a dried herb that can be brewed like tea. It also comes as a capsule or liquid supplement. It can be used to treat headache, low back pain, osteoarthritis,and many other conditions.
However, willow bark can cause stomach upset, may slow down your kidneys, and can prolong bleeding time, just like aspirin. It should only be used by adults. It could be poisonous to children, just like aspirin can be poisonous when taken in large quantitates.
If you’re sensitive to aspirin, or if you are taking any over the counter anti-inflammatory drugs (e.g., aspirin, ibuprofen, naproxen) you should avoid willow bark. You should also avoid taking it if you are taking warfarin or other anticoagulant treatments, as salicin could increase the risk of bleeding.
Part 3 of 7: Turmeric

Turmeric

turmeric
Turmeric is a spice that gives curry, an Indian dish, its yellow color and unique flavor. It contains the compound curcumin, an antioxidant that helps protect the body from free radical molecules that can damage cells and tissue.
Turmeric is used for the treatment of many conditions, including indigestion, ulcers, stomach upset, psoriasis, and even cancer. Some people with osteoarthritis turn to turmeric as a natural pain reliever because it helps relieve inflammation.
Part 4 of 7: Cloves

Cloves

ground cloves and whole cloves
Whole cloves are often used to spice up meat and rice dishes. Ground cloves are used in pies and many other foods. As a medicine, cloves can be found in capsule or powder form. Clove oil is also available.
Like other herbal supplements, cloves are used to treat a wide range of conditions. Cloves may help ease nausea and treat colds. They may also help relieve the pain associated with headaches, arthritic inflammation, and toothaches. Cloves can also be used as part of a topical pain reliever.  A study indicated that cloves could be used to treat fungal infections but further research is needed.
The active ingredient is eugenol, which is a natural pain reliever and is also used in some over-the-counter pain rubs. Rubbing a tiny amount of clove oil on your gums may temporarily ease toothache pain until you can get to a dentist. But too much undiluted clove oil may actually hurt your gums, so discuss this approach with your dentist before trying it at home. 
People with bleeding disorders or who are taking blood-thinning medication should be careful when consuming clove products. Clove oil can increase the risk of abnormal bleeding.
Part 5 of 7: Acupuncture

Acupuncture

acupuncture needles
This ancient Chinese medical practice seeks to relieve pain by balancing the body’s natural energy pathways. The flow of energy is known as qi (pronounced CHEE). Acupuncturists place tiny, and very thin needles into your skin. The location of the insertion is related to the source of the pain. But, based on the qi, a needle may be inserted far from the part of the body experiencing pain. Acupuncture may relieve pain by causing the body to release serotonin, a “feel good” chemical that eases pain.
A study published in JAMA Internal Medicine found that acupuncture helped relieve pain associated with osteoarthritis, migraines, and various locations of chronic pain.
Part 6 of 7: Heat and Ice

Heat and Ice

heat and ice
Among the most common home remedies is applying heat and ice directly to sites of pain. While these may not seem like “surprising” pain relievers, not everyone is clear on exactly when to use ice or heat.
A strained muscle, tendon, or ligament may feel better after applying an ice pack to reduce swelling and inflammation, shortly after it is injured. Interestingly, once the inflammation has disappeared, heat may help reduce the stiffness that comes with strains and sprains.
A cold pack used briefly on the head may also help take away the pain of a headache.
But, if the painful problem is arthritis, moist heat applied to the affected joint will help more than ice. Moist heat packs that can be warmed in the microwave and used many times, making them easy and effective to use. If you get injured, talk with your doctor or pharmacist about how to use heat or ice to help ease the pain.
Part 7 of 7: Be Careful

Be Careful Managing Pain

The natural painkillers described above may only be effective for specific causes of pain. It’s possible that not all of the suggestions on this list will work for you. However, these natural alternatives to prescription or over-the-counter medications may at least give you some decent options to try before you turn to pharmacological solutions.
Remember, pain is the body’s signal that something is wrong. It may be temporary, such as a strained muscle. But pain can also mean you have a serious health problem that needs a professional medical evaluation. Don’t hesitate to seek out a healthcare provider to diagnose the source of your pain, and then discuss some natural options for treating it.

Friday, April 3, 2015

Cancer, The Emperor of All Maladies




The C word.....is still a feared word, however today there is much hope for many patients with cancers. Cancer is no longer a meaningful generic word .  Compare it to saying you have an infection rather than  saying you have 'ebola'.  The immediate. emotional responses are quite different.

And so it is with many diseases, like HIV and AIDs, still feared but now manageable.  Many live long productive lives with diseases such as HIV.

Are you rich or are you poor ?  Unfortunately it makes a difference .  

This weekend PBS and WETA will be broadcasting a series of events focused on cancer.

Thanks to WETA and PBS as well as Ken Burns (producer)

Watch the Trailer


KEN BURNS
Executive Producer and Series Creative Consultant
Ken Burns has been making documentary films for more than 30 years. Since the Academy Award-nominated Brooklyn Bridge in 1981, he has gone on to direct and produce some of the most acclaimed historical documentaries ever made. The late historian Stephen Ambrose said of Ken’s films, 'More Americans get their history from Ken Burns than any other source.'
Ken Burns brings cancer story telling to a new peak. This series deserves and will receive many accolades from the medical communities and patient advocacy groups, not just for cancer but for many other medical topics as well.

BARAK GOODMAN

Producer and Director
Barak Goodman is co-founder of Ark Media and a principal producer, director, and writer with the company. His films for Ark Media have been nominated for an Academy Award and won multiple Emmys and Writers Guild Awards, the DuPont-Columbia, and Peabody Awards, the RFK Journalism Prize, and twice been official selections at the Sundance Film Festival.

DR. SIDDHARTHA MUKHERJEE
Author, The Emperor of All Maladies: A Biography of Cancer


Dr. Siddhartha Mukherjee’s accomplishments as both a physician and a Pulitzer Prize winning author are compelling and powerful. A cancer specialist, Sid has devoted his life to caring for victims of cancer, a disease that sickens and kills millions of people around the world each year. As a researcher, his laboratory is on the forefront of discovering new cancer drugs using innovative biological methods.

It is important to watch this video with the perspective of a TIMELINE


Wednesday, April 1, 2015

Patient-Powered Care Drives New Relationship With Physicians



You fought hard to get that health insurance card, whether it is through the affordable care act, medicare, medicaid or another source..  Perhaps you pay cash or belong to a direct payment model primary care practice.  Or perhaps you are still among those who could not afford health insurance even with the subsidies calculated from the Affordable Care Act's Health.gov website.


Whether your present that card with a zero-dollar copay or zero dollar deductible, you have only just begun your new patient career in the future of medical care.

Even for patients who have had a consistent uniform policy through an employer based or group based coverage most patients find the true story is only known when you present that card to the receptionist or admission clerk.  Many get a surprise when they learn how their 'old policy' has changed, with new rules, copays, deductibles, and other caveats.  Your own physician probably does not know what is in your 'card' let alone your wallet.  The card is swiped, the computer screen blinks several times and the truth will out you. God forbid it says 'declined'....you are relegated to the status of a non-citizen in the digital health sphere.  Go to start, and revert to old fashioned cash. (some are still bogged down or never left that niche)..

More likely the computer screen  will display what insurance is in effect, deductibles, copays, prior authorization requirements and much more.  The clinic EHR system is most likely connected directly to multiple insurance companies, billing agencies, hospitals and now to a nationwide health data exchange to increase transparency, and improve efficiency (when and if it is working).

Doctors, go back to your patient rooms, this stuff is not for the faint of heart and you will need all of your energy, commitment and discipline to do what you know best for your patients. Cardiac arrests, CPR, seizures, gunshot wounds are all trivial in the face of a 17% carve out of the U.S. GDP for health costs. Should you want to know more about the business of medicine you would have to have been in medical practice for at least 20 years, and have had several near misses at practice insolvency and you will need to get an MBA. 




It used to be that having an M.D. degree was the end all. Not so anymore. Many young physicians in training or early practice are enrolling in an MBA program,  perhaps on one of those MOOCs , through Coursera  or taking evening courses at the local college.  Some have learned by OJT working through the ranks of managing their clinic departments or managing their own practice in years gone by.



For more about Paient Powered Care:

Rx: A Quiet Revolution
An Interview With Cardiologist Turned Documentary Producer Jennifer Mieres
Bob Harrington interviews Jennifer Mieres about the PBS documentaries Rx: The Quiet Revolution and Rx: Doctors of Tomorrow, on innovative models for practicing and teaching patient-centered care.

PBS Documentary Champions Patient-Centered Care
Airing on April 2, 'Rx: A Quiet Revolution' turns aside from the usual discontents of medicine to show how reviving the physician-patient relationship can help Americans cope with chronic illness. 

Expert Reviews
Primary Care Models: Not One Size Fits All
A Perspective From Reid Blackwelder, MD, Board Chair, AAFP

Healthcare As It Is, or As We Want It to Be?
Professor of medicine Mark Williams reflects on the meaning of healthcare models shown in the PBS short film.

A PCMH Model That Works
Brad Fox, MD, a practicing family physician, reflects on the success of the PCMH depicted in an Alaskan practice described in the PBS film.

Transforming Primary Care, One House Call at a Time
Kenneth Lin, MD, discusses how a new documentary demonstrates the value of house calls in primary care, and why they should be reimbursed for that value.

Diabetes in the Delta: Helping Patients Meet Goals
Dr Dace Trence reviews an upcoming PBS documentary that addresses a Mississippi program for diabetes patients.

Rx: The Quiet Revolution: Heart and Soul Meet Modern Medicine
After so many doom-and-gloom healthcare documentaries, Seth Bilazarian is pleasantly surprised to find Rx: The Quiet Revolution to be both representative of his experience and insightful.

Healthcare Is a Team Sport; Nurses Are Key Players
Ken Miller, president of the American Association of Nurse Practitioners, explains how healthcare has also become a team effort, as highlighted by the PBS documentary.

Transforming Medical Education
Emotional Education in PBS's Rx: Doctors of Tomorrow
Medical student Alexa Mieses reviews the PBS documentary Rx: Doctors of Tomorrow. The program focuses on an innovative medical school that highly values empathy and emotional experience


Providers must be aware that illness can severely impair patient judgment and the ability to be self empowered during acute and some chronic illnesses.   Patient advocacy will become even more important as  providers and hospitals may fail to discharge their duties toward patients. It's all in the small print.

So let's not abdicate our position of leadership in caring for patients and monitoring just how well or not our 'allied' staff performs.

THIS IS NOT AN APRIL FOOL DAY JOKE.

Medicare to cut Physician Reimbursement by over 20 % Today


21 percent cut to Medicare now in effect


As of midnight last night, the current sustainable growth rate (SGR) patch expired, meaning the 21 percent cut in Medicare payments is in effect. Every day that the U.S. Senate does not act causes disruptions to physician practices and puts more patients at risk of not getting the care they deserve.
Last week, the U.S. House of Representatives overwhelmingly passed bipartisan legislation that would permanently repeal the SGR formula, but the Senate failed to act before leaving on a two-week recess.
While Senate leadership has indicated they will take up the bill upon return on April 13, the clock is ticking. The administration can only hold claims until April 15, leaving a very narrow window of time for the Senate to act before Medicare claims are paid at the drastically reduced rate.

We need you to keep the pressure on during the recess! Please contact your senators today to remind them that they have unfinished business here in Washington, D.C., and urge them to support H.R. 2 immediately when they return!
  1. Call your senators district offices using the AMA's toll-free Grassroots Hotline: (888) 434-6200.
  2. Send an urgent email to your senators reinforcing the need for SGR repeal now.
  3. Contact key senators still undecided on this most critical issue directly through their own social media channels and share with your own Facebook friends and Twitter followers as well.
  4. For help scheduling a district meeting or to find a list of district town halls this recess, email grassroots@ama-assn.org and we can assist you with office hours and locations.
This is urgent! The current SGR patch has expired; physicians are being hit with a 21 percent cut to Medicare - your voice is needed now, more than ever!
For more information read the bill summary (PDF) and be sure to check out fixmedicarenow.org for all the latest.

The Senate  went on recess prior to approving the House approval of the SGR Revocation Bill.
Not unusual, and the type of action that promotes apathy about our government taking meaningful action in a timely fashion... Another reason why your healthcare should not be competing with other congressional responsibilities, such as defense, terrorism and federal emergencies....

For more information, please visit: 


AMA Physicians' Grassroots Network
 


AMPAC
 




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Tuesday, March 31, 2015

Change From the Inside Out: Health Care Leaders Taking the Helm

Even as politicians and pundits continue to debate the merits of the Affordable Care Act (ACA), it is time to look beyond it to the next phase of US health care reform. Although many physicians contributed to the development and implementation of the ACA, the forces that have steered it so far have been primarily governmental.

The ACA has set the stage. The law has 2 major thematic aspects. The first, and by far the most visible in public discourse, extends health care coverage through a combination of Medicaid expansion and subsidies on newly established private insurance marketplaces. The second aspect of the ACA, far less often discussed in the public arena, is not about coverage; it is about changing the way in which health care is delivered and experienced. The mechanisms the ACA offers are numerous and the potential is profound. The response to this second theme, changing care, has been substantial, accelerating the adoption of new care structures in both the public and private sectors

Continued reliance on the ACA alone is wholly insufficient to accelerate delivery system reform to the level needed.


Leaders from within health care should now more firmly take the tiller. To borrow a phrase contributed by Splaine and colleagues.   it is time to move from change forced from the “outside in” to change led from the “inside out.”

Today’s polarized politics too often prevent authentic dialogue and exploration in the public arena that are essential in designing a better system of care. For example, the toxic and ill-informed “death panel” rhetoric in Washington stalled meaningful policies to improve the care of those with advanced illness

Needed, and now forming under the aegis of the Institute for Healthcare Improvement, is a Leadership Alliance of major health care organizations that commit publicly to partnering with their patients, and
their communities.

The current ongoing discussions about repeal of the ACA are moot, and assembling a littany of complaints  skirts the real issues.

The Supreme Court is currently reviewing the ACA

Oral Arguments for King V. Burwell

The arguments have little to do with health care and paient welfare, and much to do with the balance of powers in the three powers of government,  constitutional law, and self-interest groups.


Author commentary:

Local communities of providers, hospitals and organizations now should come to the table, and mold what little is left to adapt to practical, viable and credible trustworthy solution to another miscarriage of congressional law.  ..  Nancy Pelosi...you passed it, we read it, and now will fix what you were paid to legislate.  It can be done.........IOM, AHRQ, and other lofty non clincal health leaders please move to the back of the bus....now.

We should not expect national government to fix our own local health issues.

ARTICLE INFORMATION

Published Online: March 26, 2015. doi:10.1001/jama.2015.2830.
Conflict of Interest Disclosures: All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none were reported.

REFERENCES

1. Splaine M, Batalden P, Nelson E, Plume SK, Wasson JH. Looking at care from the inside out: a conceptual approach to geriatric care.J Ambul Care Manage. 1998;21(3):1-9. 
2. Leavitt Partners. Growth and dispersion of accountable care organizations: June 2014 update. http://leavittpartners.com/2014/06/growth -dispersion-accountable-care-organizations -june-2014-update/. Accessed March 12, 2015. 
3. National Committee for Quality Assurance. Patient-centered medical homes. http://www.ncqa .org/Portals/0/Newsroom/2013/pcmh%202011 %20fact%20sheet.pdf. Accessed March 12, 2015. 
4. Berwick DM, Nolan TW, Whittington J. The Triple Aim: care, health, and cost. Health Aff (Millwood). 2008;27(3):759-769. 
5. Gerhardt G, Yemane A, Hickman P, Oelschlaeger A, Rollins E, Brennan N. Medicare readmission rates showed meaningful decline in 2012. Medicare Medicaid Res Rev. 2013;3(2). 
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